Chapter 64: Crisis Theory and Intervention

The nurse is caring for a client with severe depression. Which activity is appropriate for this client? 1. A puzzle 2. Drawing 3. Checkers 4. Paint by number

2 Rationale: Concentration and memory are poor in a client with severe depression. When a client has a diagnosis of severe depression, the nurse needs to provide activities that require little concentration. Activities that have no right or wrong choices or decisions minimize opportunities for the client to put down himself or herself. The nurse can also process the client's feelings by sitting with the client and talking or encouraging the client to write in a journal. Test-Taking Strategy: Note that options 1, 3, and 4 are comparable or alike, in that they all require concentration. It is important to remember that clients with depression have difficulty concentrating and need activities that require little concentration.

The police arrive at the emergency department with a client who has seriously lacerated both wrists. Which is the initial nursing action? 1. Administer an antianxiety agent. 2. Examine and treat the wound sites. 3. Secure and record a detailed history. 4. Encourage and assist the client with venting their feelings.

2 Rationale: The initial nursing action is to examine and treat the self-inflicted injuries. Injuries from lacerated wrists can lead to a life-threatening situation. Other interventions may follow after the client has been treated medically. Test-Taking Strategy: Note the strategic word, initial. Use Maslow's Hierarchy of Needs Theory to prioritize. Physiological needs come first. Option 2 addresses the physiological need.

An older client is a victim of elder abuse, and the client's family has been attending weekly counseling sessions. Which statement by the abusive family member indicates that he or she has learned positive coping skills? 1. "I will be more careful to make sure that my father's needs are met." 2. "Now that my father is moving into my home, I will need to change my ways." 3. "I feel better able to care for my father now that I know where to obtain assistance." 4. "I am so sorry and embarrassed that the abusive event occurred. It won't happen again."

3 Rationale: Elder abuse sometimes occurs with family members who are being expected to care for their aging parents. This can cause family members to become overextended, frustrated, or financially depleted. Knowing where in the community to turn for assistance with caring for aging family members can bring much-needed relief. Taking advantage of these alternatives is a positive alternative coping strategy, which many families use. Test-Taking Strategy: Focus on the subject, a coping strategy. Only option 3 identifies a means of coping with the subjects. The other options are statements of good faith or promises, which may or may not be kept in the future. Option 3 outlines a definitive plan for how to handle the pressure associated with the father's care.

Which behaviors observed by the nurse might lead to the suspicion that a depressed adolescent client could be suicidal? 1. The client gives away a DVD and a cherished autographed picture of the performer. 2. The client runs out of the therapy group swearing at the group leader and then runs to their room. 3. The client gets angry with her roommate when the roommate borrows their clothes without asking. 4. The client becomes angry while speaking on their cell phone and slams the phone down on her bed.

1 Rationale: A depressed, suicidal client often gives away that which is of value as a way of saying "goodbye" and wanting to be remembered. Options 2, 3, and 4 identify acting-out behaviors. Test-Taking Strategy: Options 2, 3, and 4 are comparable or alike in that they deal with anger and "acting-out behaviors," which are often typical of some adolescents. Option 1 is different in nature and could indicate that the client may be saying goodbye.

A client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. What is the nurse's most important intervention to maintain client safety? 1. Request that a peer remain with the client at all times. 2. Remove the client's clothing and place the client in a hospital gown. 3. Assign a staff member to the client who will remain with him or her at all times. 4. Admit the client to a seclusion room where all potentially dangerous articles are removed.

3 Rationale: Hanging is a serious suicide attempt. The plan of care must reflect action that will promote the client's safety. Constant observation status (one-on-one) with a staff member who is never less than an arm's length away is the safest intervention. Test-Taking Strategy: Note the strategic words, most important. Also focus on the subject, suicide. Eliminate option 4 because seclusion would not be the initial intervention. Eliminate option 1 next because the responsibility to safeguard a client is not the peer's responsibility. Eliminate option 2 because removing one's clothing will not maximize all possible safety strategies.

The nurse observes that a client with a potential for violence is agitated, pacing up and down in the hallway, and making aggressive and belligerent gestures at other clients. Which statement is appropriate to make to this client? 1. "You need to stop that behavior now!" 2. "You will need to be placed in seclusion!" 3. "What is causing you to become agitated?" 4. "You will need to be restrained if you do not change your behavior."

3 Rationale: The best statement is to ask the client what is causing the agitation. This will assist the client with becoming aware of the behavior and will assist the nurse with planning appropriate interventions for the client. Option 1 is demanding behavior, which could cause increased agitation in the client. Options 2 and 4 are threats to the client and are inappropriate. Test-Taking Strategy: Focus on the subject, an aggressive client. Eliminate option 1 because of the demand that it places on the client. Eliminate options 2 and 4 because they indicate threats to the client.

The nurse is assisting with creating a plan of care for the client in a crisis state. When developing the plan, the nurse would consider which about a crisis response? 1. A crisis state indicates that the individual is suffering from a mental illness. 2. A crisis state indicates that the individual is suffering from an emotional illness. 3. Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis. 4. A client's response to a crisis is individualized, and what constitutes a crisis for one person may not constitute a crisis for another person.

4 Rationale: Although each crisis response can be described in similar terms as far as presenting symptoms are concerned, what constitutes a crisis for one person may not constitute a crisis for another person because each is a unique individual. Being in a crisis state does not mean that the client is suffering from an emotional or mental illness. Test-Taking Strategy: Eliminate option 3 because of the closed-ended word, all. Next, eliminate options 1 and 2 because a crisis does not indicate "illness."

The nurse is assisting with planning the care of a client being admitted to the nursing unit who has attempted suicide. Which priority nursing intervention would the nurse include in the plan of care? 1. One-to-one suicide precautions 2. Suicide precautions, with 30-minute checks 3. Checking the whereabouts of the client every 15 minutes 4. Asking the client to report suicidal thoughts immediately

1 Rationale: One-to-one suicide precautions are required for the client who has attempted suicide. Options 2 and 3 are not appropriate, considering the situation. Option 4 may be an appropriate nursing intervention, but the priority is stated in option 1. The best option is constant supervision so that the nurse may intervene as needed if the client attempts to cause harm to him or herself. Test-Taking Strategy: Note the strategic word, priority. Recalling that one-to-one suicide precautions are the priority in caring for a suicidal client will direct you to the correct option.

The nurse is gathering data from a client in crisis. When determining the client's perception of the precipitating event that led to the crisis, which is the most appropriate question to ask? 1. "With whom do you live?" 2. "Who is available to help you?" 3. "What leads you to seek help now?" 4. "What do you usually do to feel better?"

3 Rationale: The nurse's initial task when gathering data from a client in crisis is to assess the individual or family and the problem. The more clearly the problem can be defined, the better the chance a solution can be found. Option 3 will assist with determining data related to the precipitating event that led to the crisis. Options 1 and 2 identify situational supports. Option 4 identifies personal coping skills. Test-Taking Strategy: Note the strategic words, most appropriate, and focus on the subject, precipitating event. Eliminate options 1 and 2 because these data will determine support systems. Eliminate option 4 because this question would be asked when determining coping skills.

The nurse is planning care for a client who is being hospitalized because the client has been displaying violent behavior and is at risk for potential harm to others. The nurse would avoid which intervention in the plan of care? 1. Facing the client when providing care 2. Ensuring that a security officer is within the immediate area 3. Keeping the door to the client's room open when with the client 4. Assigning the client to a room at the end of the hall to prevent disturbing the other clients

4 Rationale: The client needs to be placed in a room near the nurses' station and not at the end of a long, relatively unprotected corridor. The nurse would not isolate himself or herself with a potentially violent client. The door to the client's room would be kept open, and the nurse must never turn away from the client. A security officer or male aide needs to be within immediate call in case the possibility of violence is suspected. Test-Taking Strategy: Focus on the subject, the intervention to avoid. This indicates the need to select the incorrect intervention. Keeping in mind that safety is the subject will direct you to the correct option.

The nurse is reviewing the health care record of a client admitted to the psychiatric unit. The nurse notes that the admission nurse has documented that the client is experiencing anxiety as a result of a situational crisis. The nurse would determine that this type of crisis could be caused by which event? 1. Witnessing a murder 2. The death of a loved one 3. A fire that destroyed the client's home 4. A recent rape episode experienced by the client

2 Rationale: A situational crisis is associated with a life event. External situations that could precipitate a situational crisis include loss or change of a job, the death of a loved one, abortion, change in financial status, divorce, and severe illness. Options 1, 3, and 4 identify adventitious crises. An adventitious crisis relates to a crisis, disaster, or event that is not a part of everyday life, is unplanned, and is accidental. Test-Taking Strategy: Focus on the subject, situational crisis. This will assist in eliminating options 1, 3, and 4 because they are comparable or alike.

The nurse is preparing to care for a dying client and several family members are at the client's bedside. Which therapeutic techniques would the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Extend touch, and hold the client or family member's hand if appropriate. 6. Be honest and truthful, and let the client and family know that you will not abandon them.

3, 5, 6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and family want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse would encourage expression of feelings, concerns, and fears, as well as reminiscing. The nurse needs to be honest and truthful and let the client and family know that they will not be abandoned. It is important to extend touch and to hold the client or family member's hand if appropriate. Test-Taking Strategy: Recalling therapeutic communication techniques and client and family rights will assist you in answering this question.

A client experiencing a severe major depressive episode is unable to address activities of daily living. Which is the appropriate nursing intervention? 1. Feed, bathe, and dress the client as needed until the client can perform these activities independently. 2. Offer the client choices and consequences to the failure to comply with the expectation of maintaining activities of daily living. 3. Structure the client's day so that adequate time can be devoted to the client's assuming responsibility for the activities of daily living. 4. Have the client's peers confront the client about how their noncompliance with addressing activities of daily living affects the milieu.

1 Rationale: The client with depression may not have the energy or interest to complete activities of daily living. Often, severely depressed clients are unable to perform even the simplest activities of daily living. The nurse assumes this role and completes these tasks with the client. Options 2 and 3 are incorrect because the client lacks the energy and motivation to perform these tasks independently. Option 4 will increase the client's feelings of poor self-esteem and unworthiness. Test-Taking Strategy: Note the subject, severe major depressive episode. Eliminate options 2 and 3 because the client lacks the energy and motivation to do these independently. In addition, option 2 may lead to increased feelings of worthlessness as the client fails to meet expectations. Option 4 will increase the client's feelings of poor self-esteem and unworthiness.

During a conversation with a depressed client on a psychiatric unit, the client says to the nurse, "My family would be better off without me." The nurse would make which therapeutic response to the client? 1. "Have you talked to your family about this?" 2. "Everyone feels this way when they are depressed." 3. "You will feel better once your medication begins to work." 4. "You sound very upset. Are you thinking of hurting yourself?"

4 Rationale: Clients who are depressed may be at risk for suicide. It is critical for the nurse to assess suicidal ideation and plan. The client needs to be directly asked if a plan for self-harm exists. Options 1, 2, and 3 are not therapeutic responses. Test-Taking Strategy: Use therapeutic communication techniques. Option 4 is the only option that deals directly with the client's feelings. Additionally, clients at risk for suicide need to be directly assessed regarding the potential for self-harm.

The nurse is caring for an older adult client who has recently lost her husband. The client says, "No one cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? 1. "Right! Why not just 'pack it in'?" 2. "That seems rather unlikely to me." 3. "I don't believe that, and neither do you." 4. "You must be feeling all alone at this point."

4 Rationale: The client is experiencing loss and is feeling hopeless. The therapeutic response by the nurse is the one that attempts to translate words into feelings. In option 1, the nurse uses sarcasm, which gives advice and is nontherapeutic as a nursing response. In option 2, the nurse is voicing doubt, which is often used when a client verbalizes delusional ideas. In option 3, the nurse is disagreeing with the client, which implies that the nurse has passed judgment on the client's ideas or opinions. Test-Taking Strategy : Use therapeutic communication techniques. Option 4 is the only option that focuses on the client's feelings.